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1. Introduction
The main objective of this paper is to understand the effects of different
cultural behaviours on health and well-being. The aim will be to explore certain
factors which may bear an impact on the overall health and well-being of
individuals and these factors may include genetic inheritance, access to good
quality healthcare, the general external environment, the socio-economic status
as well as other countries and their attitudes to health. Additionally, this paper
will evaluate the effects of different perspectives on health and well-being.
One can draw a distinction between physical health, mental health and social
health. The World Health Organization (WHO) draws such a distinction of mental
health by defining it as being a state of well-being. "Health is a state of complete
physical, mental and social well-being and not merely the absence of disease or
infirmity." (www.who.int)
Culture can be defined as, the ideas, customs, and social behaviour of a
particular people or society. (oxforddictionaries.com) In terms of the influence of
cultural behaviours on health and well-being, it is explained that, Health is
determined by several factors including genetic inheritance, personal behaviors,
access to quality health care, and the general external environment (such as the
quality of air, water, and housing conditions). In addition, a growing body of
research has documented associations between social and cultural factors and
health. (Berkman and Kawachi, 2000) (Marmot and Wilkinson, 2006)

2. Factors influencing health and well-being


2.1 Genetic Inheritance
Our genes are the key to many of our physical appearances, from our noses
to our hips, lips, height and even eye color. We inherit these genes from our
biological parents. Our genes can also play a role with regards to inheriting
diseases. One of the most common hereditary diseases among white Caucasians

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populations in Western Europe, North America and Australia is Cystic Fibrosis


(CF).
Cystic Fibrosis (CF) affects our secretory and sweat glands, but mostly affects
the lungs, pancreas, liver, intestines, sinuses and sex organs. CF causes mucus
build up in the breathing passages of the lungs and causes infections that often
lead to lung damage. The mucus makes it difficult for the pancreas to function
correctly and this makes it hard for the body to absorb nutrients from the food.
CF could result in life-threatening infections and serious digestion problems.
Unless one is not familiar (by way of family or friends) with CF or CF related
diseases, there is evidence to suggest that there is a general lack of knowledge
within society. The lack of knowledge relating to CF and CF-related diseases,
combined with poor access to medical facilities, leads to CF being highly underdiagnosed in Latin America, Africa and the Indian continent. Consequently, low
life-expectancies are found in these regions. However, CF appears to be well
documented in Europe. In France, for example, there is a very high incidence of
CF

in

Northwest

Brittany

and

lower

incidence

(http://www.nlm.nih.gov/medlineplus/ency/article/000107.htm).

in

the
Due

South
to

the

documentation of CF in Europe and with the reportedly high prevalence of the


disease, education and medical facilities are of a better quality and therefore
afford an increase in life expectancy for these patients.
In the past figures suggested that the life expectancy for patients with CF
averaged on thirty years of age. It would however be misleading to suggest that
there is an average on life expectancy that one could use as a standard guide
when assessing CF, as patients are diagnosed at different ages and affect people
differently.
CF is only one of many diseases that are genetically inherited. Research
suggests that we will be able to find out which conditions one is most likely to
develop and/or inherit through one or a combination of the following: our genes
passed on to us by our parents and with our lifestyles and the environmental
changes.

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In other countries and cultures we find various other genetic diseases.


According to Eanet, K. & Rauch, J. (2000), certain ethnic groups carry genes for
certain diseases. The condition, at-risk population, and approximate carrier
frequency within the USA are listed below:

Sickle Cell Anemia - African Americans - 1/10


Tay-Sachs Disease - Eastern European Jews & French Canadians - 1/25
lpha-Thalassemia - Greeks, Italians - 1/30
Beta-Thalassemia - Southeast Asians & Chinese - 1/25
Cystic Fibrosis - Northern Europeans - 1/20
Cystic Fibrosis - Eastern European Jews - 1/30
Phenylketonuria - Northern Europeans - 1/30

There are a number of diseases that one could list and discuss that have been
impacted by culture and area. Perhaps the best known example would be sickle
cell anaemia. If one looks at geographical patterns, there is sufficient evidence to
suggest that one finds this in malaria infected areas. The gene variant to sickle
cell disease is related to malaria, not skin colour. Unfortunately malaria is
predominantly found in third world counties within Africa with poor infrastructure,
lack of education regarding sickle cell anaemia and access to quality health care
is nearly non-existent.
In the UK, about 12,500 people have SCD. It is more common in people
whose family origins are African, African-Caribbean, Asian or Mediterranean. It is
rare in people of North European origin. On average, 1 in 2,400 babies born in
England have SCD, but rates are much higher in some urban areas - about 1 in
300 in some places.
SCD is now one of the most common inherited conditions in babies born in the
UK.

(http://www.patient.co.uk/health/Sickle-Cell-Disease-and-Sickle-Cell-

Anaemia.htm)
2.2 Access to good health care
It is important to all of us to have good access to healthcare, this will
however differ depending the country and area we live in. Access to healthcare
has a great impact on our well-being.

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People in poor countries tend to have less access to health services than those
in better-off countries, and within countries, the poor have less access to health
services. Although a lack of financial resources or information can create barriers
to accessing services, the causal relationship between access to health services
and poverty also runs in the other direction. When health care is needed but is
delayed or not obtained, peoples health worsens, which in turn leads to lost
income and higher health care costs, both of which contribute to poverty
(Annals of the New York Academy of Sciences Volume 1136, Issue 1)

FIGURE 1. Conceptual framework for assessing access to health services.


Figure 1 illustrates, the 4 main elements that influence our access to healthcare
(working from the centre of the framework):
1. Geographical
a. How long does it take us to get to a service delivery point?
b. How far is the service delivery point from our location?
2. Availability
a. Operational hours?
b. What type of services is available?
c. What are the waiting times?
3. Financial
a. What is the relationship between the cost of the service and the
willingness and ability of the users to pay for it? (especially
dentistry)
b. What is the economic health cost having the services there?
4. Acceptability
a. Response between health service providers and individuals (social
and cultural expectations) or communities
b. Expectations from the user
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In the UK (compared to other countries) we are extremely fortunate to


have access to health care however the accessibility and quality is still
influenced by many factors.
The NHS was created out of the idea that everyone should have access to
good healthcare regardless of your Socioeconomic Status. When it was
launched by the then minister of health, Aneurin Bevan, on July 5 1948, it was
based on three core principles: that it meet the needs of everyone , that it be
free at the point of delivery, that it be based on clinical need, not ability to pay .
These three principles have guided the development of the NHS over more
than 60

years

and

remain

at

its

core.

(http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx)
Even though the core principles might be true to all UK & EU Citizens living
within the UK, the quality and access may vary hugely. People who live in major
cities (London, Manchester, Liverpool, and Birmingham to name but a few) have
more access to services than people living in rural areas (Cherwell, Wealden,
Newark and Sherwood and East Devon to name but a few). The proximity of the
services differs greatly as well as the types of services available.
Where one resides in the UK is not the only concern regarding access to
health care; ones occupation will also influence ones access to health care (the
hours one works, the type of employment, whether or not one is able to take
time off from work), including language and ones belief system. All these things
play a significant role in access to health care.
The lists which proceed, are a few samples of cultural beliefs that will
significantly impact on access to health care:

Asians
o Have a significant extended family influence, the oldest male in the
family is often the decision maker and spokesperson. The interests
and honour of the family are far more important than the individual
o

family members.
Western medicine focus on an assumption that external factors (i.e.
bacteria or virus) needs to be treated and that disease is either
mental or physical, whereas Eastern medicine assumes that the
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body is a whole, mental and physical is one and each part of the
o

body is connected.
Example of the above points:
An individuals behaviour reflects on the family, any illness or
mental illness may therefor produce shame or guilt. These
patients may be reluctant to discuss these things due to the
shame or guilt denying themselves the access to health care
available

Indian
o Often reluctant to accept any diagnosis of mental or emotional
illnesses as this could reduce the chances of other members within
o

the family of getting married


Often use faith and spiritual healing rituals yoga could eliminate

certain physical and mental illnesses


Hindus believe that disease is due to ones actions in past lives

due to karma
Hindus prefer to die at home due to their religious rituals that may
need to be performed, this could restrict access to life saving health
care

Religion also has an impact on our health, Iulia O. Basu-Zharku wrote


health behaviours (through prescribing a certain diet and/or discouraging the
abuse of alcoholic beverages, smoking, etc., religion can protect and promote a
healthy lifestyle), social support (people can experience social contact with coreligionists and have a web of social relations that can help and protect
whenever the case), psychological states (religious people can experience a
better mental health, more positive psychological states, more optimism and
faith, which in turn can lead to a better physical state due to less stress) and psi
influences (supernatural laws that govern energies not currently comprehended
by science but possibly understandable at some point by science). Because
spirituality/religion influence health through these pathways, they act in an
indirect way on health (Oman & Thorensen, 2002) There are studies that show
the positive impact of fasting and health benefits to religious lifestyles.
2.3 General external environment
Environmental health risks are factors outside of the body that can affect
a person's wellbeing. Examples include the quality of their air, food and water
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supply or their exposure to hazardous materials. Preventing or reducing the risk


of illness, injury or disease in the community is important for environmental
health.
(http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Environmental_h
ealth?open)
Environmental health covers many different factors in a persons surroundings.
These can include:
External

Example

Environment
Air Pollution
Water quality
Food quality
Chemicals
Metals
Infectious

Smog, wood smoke, mould


Grey water, tank water, fluoridation and drought
Contamination and nutrition
Pesticides, farm chemicals and arsenic
Exposure to lead, mercury and cadmium
Viral infections like swine flu

diseases
Man-made

Exposure to asbestos, or electromagnetic radiation like

structures

mobile phones

Air pollution is a major health risk and leads to poor air quality that
impacts an increased rate in repertory diseases. Just as densely populated areas
has a high risk of airborne diseases that could easily spread.

The travelling community in the UK has increased over the last couple of
years and their health and well-being is especially influence by their external
environment. Many of the 350 public Gypsy sites are situated in hostile
environments that are deemed unsuitable for any other development, such as on
old waste tips, or beside or underneath motorways. (Health care needs of
Travellers - http://adc.bmj.com/content/82/1/32.full#sec-1)

The environments these communities choose to settle in for certain


periods are usually well away from local amenities. Other problems on authorised
sites include health hazards, decayed swages and water fittings, poor quality
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utility rooms and failings in fire safety. Poor quality accommodation aggravate
existing heath conditions and could lead to new problems, higher infection rates
are linked to poor sanitation and poor access to clean water.

Due to these communities traveling often and or in short notice periods


there seems to be a lack in education in younger children and the immunisation
of children leading to a lack of knowledge and higher childrens diseases.

2.4 The socio-economic status


Social and economic resources shape the health of individuals and
populations. This can be seen in the simple statistic that richer countries tend to
have better average health than poorer ones (Wilkinson, 1996).

The diagram above reflects that socio-economic status (SES) is often


measured as a combination of education, income, and occupation.

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Lifestyle choices (employment, education, housing, diets and sleep) have


a direct correlation between our socio-economic status and our health.

In

developed countries people with low socio-economic statuses have poor health
behaviour (smoking,

bad

food

choices,

physical

inactivity,

over

alcohol

consumption) that leads to various health matters. Where as in underdeveloped


countries, low socio-economic status relates to poor living conditions, bad water
and sanitation, malnutrition, unemployment with poor housing conditions which
leads to diseases such as TB, cardiovascular diseases and aids, with high
mortality rates.
It is estimated that people on higher incomes enjoy better sleep patterns
than those on lower incomes, which has a direct impact on ones mood and
stress levels, which in turn causes depression, psychological distress and a
weakened immune system that could all be associated with future diabetes,
increased obesity, heart diseases

and some form of cancers. Studies have

shown that healthy people often get promoted in the workplace where as
unhealthy people are often not or unemployed.
Those deprived economically and living in disadvantaged neighbourhoods
face a variety of chronic stressors in daily living: They struggle to make ends
meet; have few opportunities to achieve positive goals; experience more
negative life events such as unemployment, marital disruption, and financial
loss;

and

must

deal

with

discrimination,

marginality,

isolation,

and

powerlessness (Lantz et al. 2005)


2.5 Other countries and their attitudes to health
Ethiopia
Ethiopia has an underdeveloped health system with almost 80 percent of
morbidity in Ethiopia is due to unnecessary contagious and nutritional diseases,
both associated with low socio-economic development in third world countries.
Most women live in remote areas, where transportation and roads are nonexistent let alone the any health facilities. 94% of birthing takes place at home
with only 6% of women delivering in a clinic or hospital. A relative or untrained
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person will assist in 61% of births and 5% of births are unassisted. One in 14
women face the risk of dying during pregnancy or child birth, with the number
escalating even higher among poor uneducated woman.
Infant and child mortality is equally high, with 1 in 13 infants will not survive
their 1st birthday and a furthermore 1 in 8 will die before their 5 th birthday.
Marriage at the age of 7 or 8 is not unheard of in rural parts of Ethiopia. Such
early marriage and consequent pregnancy is one cause of higher rates of
maternal and infant mortality and morbidity, including from obstetric fistula, and
increased vulnerability to sexually transmitted infections (STIs), including HIV.
(http://populationaction.org/wp-content/uploads/2012/01/Health_Services.pdf)
The mortality rates are much lower in urban areas, however the mortality rate is
a direct reflection of the public health system and scares health care
infrastructure.
South Africa
South African private medical care outshines all African nations care and
even some European nations. Some private hospitals in Johannesburg, Cape
Town and Natal are centres of medical excellence and attacks tourists from other
continents. Unfortunately private health care in South Africa in beyond the reach
of 80% of the population.
The discrepancy between public and private health care is inconceivable,
the public sector is under staffed (One practising doctor for every 4219 patients)
and hugely over-subscribed, with a sever lack of diagnostic facilities and
overcrowded wards causing health hazards.
South Africa is one of the few countries in the world where child and maternal
mortality rates have risen since the 1990s because of the impact of HIV/AIDS,
which accounts for more than one-third of deaths among children under five.
(http://www.southafrica.info/about/health/health.htm#.VG1ukvmsVyU)

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One of the major concerns in South Africa is the lack of education with
regards to AIDS not just amongst poor uneducated people but also people in
power, 2 prime examples:

Dr. Manto Tshabalala-Msimang, the previous health minister of South Africa


promoted dietary measures rather than drugs to treat AIDS. Dr.
Tshabalala-Msimang advocated marshalling vitamin and nutritional forces
against the H.I.V. She said at a world health organisation conference that
foods like garlic, lemon, African potatoes and beetroot were stauncher
defences than the antiretroviral drugs and have been proved to prolong
the lives of H.I.V.-positive patients and to help prevent the passage of the
virus from pregnant women to their babies.

Ex-President Zuma's gave testimony in court that that he did not use a
condom during sex, despite knowing the woman was HIV-positive, but that
he had left his bedroom after having sex with the woman and taken a
shower because this would minimise the risk of contracting the disease
[HIV].

South Africa has one of the highest sexual violence statistics in the world,
where women have a one in three chance of being raped. There exists a belief
amongst low social-economic black men, primarily those with little or no
education, that AIDS is the result of bad spirits inhabiting the body and that
having sex with a virgin will cure AIDS. This transcends into forced sex where
young virgins and children including infants, are raped by men holding this
belief, and consequently causing severe genital damage and trauma to both the
victim and the family of the victim.

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3. Conclusion

An evaluation of health and well-being, reveals that there is a scale of varying


opinions with regards to this and what is requires to maintain it. Firstly, as
referenced at the outset of this paper, WHO purports that health is a sum total of
mental, physical and social well-being and that well-being is not exclusively
determined by the absence of disease. Secondly, certain factors such as genetic
inheritance, the external environment, socio-economic status, access to health
care and the attitudes to health in other countries, can all influence the outcome
of health and well-being. Wilkinson (1996), noted that social and economic
factors actually shape the health of individuals and populations.
As far as the effects of different perspectives on health and well-being are
concerned, this paper has revealed that certain perspectives can sometimes be
detrimental to the recipients of those viewpoints, thus inadvertently making
those on the receiving end, victims. South Africa was referenced and how on the
one hand, highly educated and qualified doctors and presidents have mistakenly
condoned

and

perpetuated

cultural

beliefs

and

practices,

thus

putting

themselves and citizens in physical jeopardy. On the other hand, lower down the
socio-economic spectrum, uneducated men have held the mistaken belief that to
rid themselves of HIV, raping young virgins will rid them of their disease.
For citizens to benefit and achieve a good and fair quality of health and wellbeing, more effort needs to be invested by governments and public services at
all socio-economic levels.

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